Membership (under 60): £15 annually Membership (60 and over): £10 annually

Contact IA What does IA do?You may have been advised that you need to have bowel surgery and an ileostomy or an internal pouch formed. You may already be living with an ileostomy or an internal pouch or caring for someone who is.

Surgery can lead to feelings such as confusion, isolation or anger. It’s a time when support from others who understand, who are living life after surgery, can make a difference.

IA offers local and national support where our volunteers are themselves living life with an ileostomy or an internal pouch. Living life to the full, enjoying the things that illness has often deprived them of or made it difficult to achieve.

Everyone has concerns following surgery. No matter how big or small you think they are, we can help. You might be thinking...

• How will I manage? • When can I return to work?• What about all the things I enjoy like holidays, sports, socialising and eating out wiith friends?

Don’t let living with a stoma or an internal pouch hold you back from enjoying all the things you love to do.

• Visiting

• Quarterly Journal

• Internal Pouch

• Website

• Young IA

• Information days

Join IA... today

Full membership is open to anyone who has an ileostomy or internal pouch.

Associate membership is available to anyone who is interested in the work of IA, such as surgeons, doctors, nurses, family and friends.

To join IA, please complete the application form and return, together with your subscription, to the address below or join online at www.iasupport.org.

How can I join IA?

• Members’ Meetings

• Kock Pouch

• Advisory Services

• Medical Research

• Family & Carer Support

IA National OfficeDanehurst Court35 - 37 West StreetRochford, EssexSS4 1BE

Phone: 0800 0184 724Email: info@iasupport.org

Application Form

Other:Mr Mrs Miss Ms

Full name:

Address:

Postcode:

Phone:

Date of birth (dd/mm/yy):

Email:

Mobile:

Surgery:

Date of operation:

Reason for surgery:

other none

ileostomy internal pouch

Gift Aid: I confirm that I wish the charity to claim Gift Aid on this payment and all payments I make from the date of this declaration. I also confirm that I have paid UK Income Tax and/or Capital Gains Tax at least equal to the amount of tax that all the charities or Community Amateur Sports Clubs that I donate to will reclaim on my behalf for each tax year. I understand that other taxes such as VAT and Council Tax do not qualify

Please send me a banker’s order

I enclose a subscription of

I also enclose a donation of

Total enclosed

£

£

£

SIGN HERE

Subscriptions (see annual subscriptions opposite)

DATE

SIGN HEREENTER NAME OF GROUP TO JOIN - SEE REVERSE

I consent to IA holding details about my medical condition to enrich the membership services offered (A summary of how we use your data is overleaf).

(Block capitals please)

How did you hear about us?:

Ileostomy and Internal Pouch Association is a company limited by guarantee. Company Number: 10375943 (England and Wales).

North of EnglandHumberside

Manchester

Merseyside

North Eastern

North West Lancashire& Cumbria

Sheffield & Rotherham

West Riding of Yorkshire

Wigan

York

MidlandsBirmingham

Coventry & District

Kettering & District

Leicestershire

Lincolnshire

Northampton

North Midlands & Shropshire

Nottinghamshire &Derbyshire

Peterborough & Wisbech

Sandwell & Walsall

Stourbridge

Three Counties -Gloucester, Hereford,Worcester

Southern EnglandAvonBerks, Bucks & OxonCornwallDevon & SomersetEast London & South EssexHampshire & IOW KentNorfolk & SuffolkNorth EssexNorth LondonSouth East London & West KentSurreySussexWest Hants, Wilts & Dorset

Wales, Scotland & IrelandNorth WalesSouth WalesFifeHighlandNorth of ScotlandTaysideWest & Central ScotlandNorthern Ireland

IA Ireland

IA Member Organisations

www.iasupport.org

Contact IA

Ileostomy?

InternalPouch?

Fair Processing Notice: Summary

What data we hold

If you join our organisation we will collect your contact details, the medical information you provide us with and your bank details so that we can take payment.

How we use your personal data

We use your personal data to assist with membership services. We also process personal data of a medical nature in order to help you and make your membership useful and meaningful. The collection of your medical information will be by your explicit consent. We will share your information with your local IA member organisation. IA will send regular communication to you regarding your membership such as renewal reminders, information and awareness events etc. We never share your details with companies providing goods and services, however from time to time you may receive information from them, but this will have been sent to you by IA on their behalf.

Your rights

You have the right to access, correct, sometimes delete and object to our processing of your personal information. You have the right to withdraw consent, where consent was previously given.

Our Fair Processing Notice(s) are available in full at www.iasupport.org/privacy and explain how we collect and use your personal information. Copies are also available by writing to the address below. If you want to get in touch our Data Protection Officer can be reached by email at dpo@iasupport.org or by post at:IA national office, Danehurst Court, 35-37 West Street, Rochford, Essex SS4 1BE.

Next review 02/2017

www.iasupport.orgReg’d Charity: 1172338 (England and Wales) and SC048658 (Scotland)Next Review: 06/2019CIA 0918_FPNv1

Ileostomy & Internal Pouch

Association

Registered Charity